HomeMy Public PortalAbout5003 CAMELLIA AVE_Plumbing__ 7aA667A' I I
CE 817(REV.11/78) !S
APPLICATI FILUM RMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING/�•
NUMBER FIXTURE OR ITEM ® FEE ADDRESS) OU-7 V. C rnQ V �'
WATER CLOSET LOCALITY m C >
NEAREST // ,
BATH TUB CR0555T, C C /T F�
SHOWER OWNER �"O C d
LAVATORY MAILADDRESS -00 7 ` VC
SINK CITY e pele C t TEL.NO. 2 PC, ?7
DISHWASHER CONTRACTORtr
A,jr,,, a Lh
CLOTHES WASHER ADDRESS CDl
SWIMMING POOL RECEPTOR q
CITY r A9 7 ,C TEL,NO.
LAWN SPRINKLER SYSTEM STATE v LIC.
WATER HEATER LICENSE NO31,7i CLASS " 2-
GAS
GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'5 SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING d
GAS PIPING V
GAS VENT w
HOT WATER HEATER O
PLUMBING FIXTURES
GAS TEST N
Plan check fee UTILITY O.NOTIFIED 2
PLUMBING PERMIT ISSUING FEE$ r Ul
TOTAL FEE FINAL ✓E• Ba -1 c —ac..- �+ �/ •-
Plan check applicant
PLAN CHECK VALIDATION
Name
1JX�
Address
City Tel.Na. �7 81.2 A
IN BY ACKNO L THAT 1 HAVE READ THIS APPLICATION AND STATE
THAT T ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALLCOUNTY ORDINANCES # O O O O O 5
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
HEREBY CEfliIFV iMAi I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 O O 1 0,00
REOUIRED By LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT IAM THE
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL �O O O 1 O.Q O U
PROPERTY,
SIGNATURE L T •11. 16779
OFPERMITTEE -
DISTRICT y^/ PROCESSED B
e'O
INDUSTRIAL
WASTE APPROVAL